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Sandra Pauls - One of the best experts on this subject based on the ideXlab platform.

  • Cisterna Chyli in patients with malignancy influence of cardiovascular disease on the prevalence of the Cisterna
    European Journal of Radiology, 2011
    Co-Authors: Sebastian Feuerlein, Rainer Muche, Hansjuergen Brambs, Jochen Stolz, M Hetzel, Oliver Klass, Sandra Pauls
    Abstract:

    Abstract The purpose of this study was to investigate the potential correlation between the presence and size of the Cisterna Chyli (CC) on computed tomography (CT) and the presence of cardiovascular disease. Materials and methods Out of a 3000-patient cohort 2599 patients who received a CT examination of the chest and/or abdomen with measurable inferior vena cava and azygos vein were included in this retrospective study. To assess the presence of cardiovascular disease the following parameters were recorded from the PACS or clinical information system: diameter of vena cava and azygos vein, presence of ascitis, serum creatinine, history of congestive heart failure, coronary artery disease or arterial hypertension and medication (diuretics, beta-blocker). In addition the volume of the CC and the presence or absence of malignant disease were recorded. Mean values (vessel diameters, creatinine) or percentages were calculated and compared for the groups with (n = 416) and without (n = 2183) a Cisterna. Multivariate logistic regression analysis was performed for all parameters to identify the potential association with the presence and size of a Cisterna. In addition the simultaneous influence of the parameter malignancy, cardiovascular disease and age on presence and size of the CC was analyzed in a logistic regression model. Results The presence or absence of a CC was not associated with any of the measured parameter. Regarding the size of the CC, there was a positive correlation with the diameter of the azygos vein, the presence of ascitis and diuretic medication. The influences of malignancy, elevated central venous pressure and age on the development of a CC proved to be highly significant but could not be separated or quantified. Conclusion The volume of the Cisterna Chyli is influenced by pathologic states with an increased central venous pressure, while the presence or absence of the Cisterna seems to be independent of those factors.

  • Cisterna Chyli in patients with malignancy is there a correlation between changes in Cisterna volume and progression or regression of the tumor
    European Journal of Radiology, 2010
    Co-Authors: Sebastian Feuerlein, Rainer Muche, Markus S Juchems, Marco Kern, Andrea S Ernst, Sandra Pauls
    Abstract:

    UNLABELLED: The purpose of this study was to investigate the potential correlation between the size of the Cisterna Chyli (CC) and the tumor size in patients with malignancies on computed tomography (CT). MATERIALS AND METHODS: Out of a 3000 patient cohort 138 patients with histologically confirmed malignant disease, a detectable CC on CT and at least two CT scans within a 6 month period were included in this retrospective study. Out of 525 scans a total of 711 lesion intervals were evaluated. The volume of the CC and all target lesions (up to three per scan) were recorded. The Pearson correlation coefficient for the two parameters of changes in lesion size and CC size was calculated for the whole cohort and for a 33 patient subgroup that included only patients with tumors that showed the closest association with large CC in a previous study. RESULTS: The mean difference in lesion size for all 711 intervals was -1165μl. The mean difference in CC size for all 711 intervals was -46.6μl. The respective Pearson correlation coefficient was .05 with a non-significant p-value of .1823 (subgroup: r=.04, p=.6358). CONCLUSION: No significant correlation between the progression or regression of malignant disease and the size of the Cisterna Chyli could be found.

  • Cisterna Chyli in patients with malignancy—Is there a correlation between changes in Cisterna volume and progression or regression of the tumor?
    European Journal of Radiology, 2009
    Co-Authors: Sebastian Feuerlein, Rainer Muche, Markus S Juchems, Marco Kern, Andrea S Ernst, Sandra Pauls
    Abstract:

    UNLABELLED: The purpose of this study was to investigate the potential correlation between the size of the Cisterna Chyli (CC) and the tumor size in patients with malignancies on computed tomography (CT). MATERIALS AND METHODS: Out of a 3000 patient cohort 138 patients with histologically confirmed malignant disease, a detectable CC on CT and at least two CT scans within a 6 month period were included in this retrospective study. Out of 525 scans a total of 711 lesion intervals were evaluated. The volume of the CC and all target lesions (up to three per scan) were recorded. The Pearson correlation coefficient for the two parameters of changes in lesion size and CC size was calculated for the whole cohort and for a 33 patient subgroup that included only patients with tumors that showed the closest association with large CC in a previous study. RESULTS: The mean difference in lesion size for all 711 intervals was -1165μl. The mean difference in CC size for all 711 intervals was -46.6μl. The respective Pearson correlation coefficient was .05 with a non-significant p-value of .1823 (subgroup: r=.04, p=.6358). CONCLUSION: No significant correlation between the progression or regression of malignant disease and the size of the Cisterna Chyli could be found.

  • the Cisterna Chyli prevalence characteristics and predisposing factors
    European Radiology, 2009
    Co-Authors: Sebastian Feuerlein, Georg Kreuzer, Stefan A Schmidt, Rainer Muche, Markus S Juchems, A J Aschoff, Hansjuergen Brambs, Sandra Pauls
    Abstract:

    The purpose of this study was to determine the prevalence and characteristics of the Cisterna Chyli (CC) in a large 3,000-patient cohort and to identify potential predisposing factors for the development of a CC. Three thousand consecutive contrast-enhanced CT examinations (1,261 women, 1,739 men, mean age 61.0 years) of the chest and/or abdomen were included in this retrospective study. Imaging characteristics of the CC (size, attenuation, location) were documented as well as clinical information (malignant disease, pattern of metastasis). A CC was found in 16.1% of the patients with an average volume of 302 µl. The mean attenuation was 4.8 Hounsfield units (HU). Twenty percent of the CC showed CT densities of 15 HU and higher. Patients with malignancies showed a significantly (p 1,000 µl) represents an elevated relative risk for malignancy of 1.7 (p = 0.0017). We found a significant association between malignant disease and the presence and size of a Cisterna Chyli. Identifying the continuity between the CC and the thoracic duct is a safer method to distinguish a CC from retrocrural lymph nodes than near-water CT attenuation alone.

  • The Cisterna Chyli: prevalence, characteristics and predisposing factors
    European Radiology, 2009
    Co-Authors: Sebastian Feuerlein, Georg Kreuzer, Stefan A Schmidt, Rainer Muche, Markus S Juchems, A J Aschoff, Hansjuergen Brambs, Sandra Pauls
    Abstract:

    The purpose of this study was to determine the prevalence and characteristics of the Cisterna Chyli (CC) in a large 3,000-patient cohort and to identify potential predisposing factors for the development of a CC. Three thousand consecutive contrast-enhanced CT examinations (1,261 women, 1,739 men, mean age 61.0 years) of the chest and/or abdomen were included in this retrospective study. Imaging characteristics of the CC (size, attenuation, location) were documented as well as clinical information (malignant disease, pattern of metastasis). A CC was found in 16.1% of the patients with an average volume of 302 µl. The mean attenuation was 4.8 Hounsfield units (HU). Twenty percent of the CC showed CT densities of 15 HU and higher. Patients with malignancies showed a significantly (p < 0.001) higher prevalence of CC (340/1,757, 19.4%) than patients with benign conditions (144/1,243, 11.6%). Especially the finding of a large CC (>1,000 µl) represents an elevated relative risk for malignancy of 1.7 (p = 0.0017). We found a significant association between malignant disease and the presence and size of a Cisterna Chyli. Identifying the continuity between the CC and the thoracic duct is a safer method to distinguish a CC from retrocrural lymph nodes than near-water CT attenuation alone.

Jonathan F Mcanulty - One of the best experts on this subject based on the ideXlab platform.

  • prospective comparison of Cisterna Chyli ablation to pericardectomy for treatment of spontaneously occurring idiopathic chylothorax in the dog
    Veterinary Surgery, 2011
    Co-Authors: Jonathan F Mcanulty
    Abstract:

    OBJECTIVE: Prospective comparison of Cisterna Chyli ablation (CCA) or pericardectomy (PC) for chylothorax. STUDY DESIGN: Randomized prospective study. SUBJECT POPULATION: Dogs with idiopathic chylothorax (n= 23). METHODS: Dogs were treated by thoracic duct ligation (TDL) with either CCA (n = 12) or PC (n = 11). Long-term outcomes, intraoperative central venous pressures (CVPs) and pericardial histology were assessed. Dogs with persistent chylothorax were offered retreatment by the alternative procedure. RESULTS: Ten (83%) dogs treated by CCA-TDL and 6 (60%) treated by PC-TDL resolved their chylothorax. Retreatment in 4 dogs resulted in resolution in 2 dogs and 2 perioperative deaths. Four dogs developed nonchylous effusions; 2 of which resolved after initiating steroid therapy, 1 of which was unsuccessfully treated by PC, and 1 continues to be managed by thoracocentesis 6.5 years later. CVPs were normal in most dogs and unaffected by PC. On histology, pericardial tissues had extensive external surface fibrosis with mild inflammation. On follow-up (≤ 6.5 years), no recurrence of pleural effusions occurred after initial resolution. CONCLUSIONS: CCA-TDL appears to offer improved outcomes over historical results with TDL. Results with PC-TDL were more variable for unknown reasons. Venous pressure measurements did not support the hypothesis that venous hypertension was involved in chylothorax or response to therapy in these dogs.

  • single paracostal approach to thoracic duct and Cisterna Chyli experimental study and case series
    Veterinary Surgery, 2011
    Co-Authors: Benjamin A Staiger, Bryden J Stanley, Jonathan F Mcanulty
    Abstract:

    OBJECTIVE: To-determine the feasibility of a single paracostal abdominal approach for thoracic duct ligation (TDL) and Cisterna Chyli ablation (CCA) in dogs with chylothorax. STUDY DESIGN: Observational study and prospective case series. ANIMALS: Normal dogs (n = 5) and dogs with chylothorax (n = 8). METHODS: A single paracostal approach with transdiaphragmatic extension for TDL and CCA was developed experimentally (n = 5) and used in 8 clinical cases with subtotal pericardectomy (SPE) performed in 4 dogs. Surgery time, complications, hospitalization time, outcome, and follow-up of clinical cases were recorded. RESULTS: Exposure of relevant anatomy was excellent; vital lymphatic staining facilitated identification of lymphatic structures. In clinical cases, mean surgery time for TDL + CCA was 136 minutes. Mean hospitalization time was 3.1 days. Seven of 8 cases survived, with 1 dog dying of heart failure shortly after discharge. One dog required a second (left) paracostal approach to ligate 2 more lymphatic vessels. On follow-up (median, 7 months; range, 2-20 months), there was complete resolution of chylothorax in 6 dogs. CONCLUSIONS: A single paracostal approach provides excellent exposure of Cisterna Chyli, caudal thoracic duct, and intestinal lymphatics. This approach eliminates the need for repositioning during combined TDL + CCA procedures and avoids an intercostal thoracotomy.

  • Prospective Comparison of Cisterna Chyli Ablation to Pericardectomy for Treatment of Spontaneously Occurring Idiopathic Chylothorax in the Dog
    Veterinary Surgery, 2011
    Co-Authors: Jonathan F Mcanulty
    Abstract:

    Objective Prospective comparison of Cisterna Chyli ablation (CCA) or pericardectomy (PC) for chylothorax. Study Design Randomized prospective study. Subject Population Dogs with idiopathic chylothorax (n= 23). Methods Dogs were treated by thoracic duct ligation (TDL) with either CCA (n = 12) or PC (n = 11). Long-term outcomes, intraoperative central venous pressures (CVPs) and pericardial histology were assessed. Dogs with persistent chylothorax were offered retreatment by the alternative procedure. Results Ten (83%) dogs treated by CCA-TDL and 6 (60%) treated by PC-TDL resolved their chylothorax. Retreatment in 4 dogs resulted in resolution in 2 dogs and 2 perioperative deaths. Four dogs developed nonchylous effusions; 2 of which resolved after initiating steroid therapy, 1 of which was unsuccessfully treated by PC, and 1 continues to be managed by thoracocentesis 6.5 years later. CVPs were normal in most dogs and unaffected by PC. On histology, pericardial tissues had extensive external surface fibrosis with mild inflammation. On follow-up (≤6.5 years), no recurrence of pleural effusions occurred after initial resolution. Conclusions CCA-TDL appears to offer improved outcomes over historical results with TDL. Results with PC-TDL were more variable for unknown reasons. Venous pressure measurements did not support the hypothesis that venous hypertension was involved in chylothorax or response to therapy in these dogs.

  • Cisterna Chyli ablation with thoracic duct ligation for chylothorax results in eight dogs
    Veterinary Surgery, 2005
    Co-Authors: Kei Hayashi, Gretchen K Sicard, Kelly L Gellasch, Joseph D Frank, Robert J Hardie, Jonathan F Mcanulty
    Abstract:

    Objective— To report use of combined Cisterna Chyli ablation (CCA) and thoracic duct ligation (TDL) for treatment of spontaneously occurring chylothorax in dogs. Study Design— Retrospective study. Animals— Eight dogs with chylothorax. Methods— TDL was performed through a right caudal intercostal thoracotomy and CCA through a left flank paracostal approach or ventral median celiotomy. Long-term outcome (range, 2–48 months; median, 11.5 months) was evaluated by telephone communication with owners. Results— Seven dogs were free of clinical signs related to chylothorax at last follow-up (range, 4–48 months; median, 15.5 months). One dog was euthanatized 2 months after surgery because of lack of improvement. No major complications occurred from CCA. Conclusion— CCA and TDL resolved chylothorax in most dogs (88%). Clinical Relevance— CCA combined with TDL may improve the outcome of chylothorax in dogs.

  • the effect of Cisterna Chyli ablation combined with thoracic duct ligation on abdominal lymphatic drainage
    Veterinary Surgery, 2005
    Co-Authors: Gretchen K Sicard, Ken Waller, Jonathan F Mcanulty
    Abstract:

    Objective— To evaluate the effect of Cisterna Chyli ablation (CCA) and thoracic duct ligation (TDL) on abdominal lymphatic drainage in normal dogs. Study Design— Experimental study. Animals— Nine female beagle dogs. Methods— TDL was performed in 3 dogs and was combined with CCA (CCA–TDL) and local omentalization in 6 dogs. Contrast lymphangiography was attempted in all dogs immediately before and after TDL. Dogs were reanesthetized at 31–37 days for lymphatic studies by new methylene blue (NMB) injection into a mesenteric lymph node and by contrast lymphangiography. Results— In 6 CCA–TDL dogs, 2 had direct shunting of contrast from the lymphatic system into major abdominal veins, 3 had contrast material that dissipated into abdominal vessels within the mesenteric root, and 1 had shunting into the azygous vein. NMB was not observed within the omental pedicle after CCA–TDL. Chylous drainage was by the azygous vein in all 3 TDL dogs. Conclusions— CCA–TDL disrupted chylous drainage to the thoracic duct and resulted in direct intraabdominal lymphaticovenous anastomoses identified by shunting of lymphatic flow directly into the abdominal vasculature in 5 of 6 CCA–TDL dogs. Omentalization of the Cisternal ablation site was not beneficial in augmenting extrathoracic lymphatic drainage and is not recommended with CCA–TDL. Clinical Relevance— CCA–TDL represents a novel approach to surgical redirection of chylous drainage to the venous circulation outside of the thorax and may be useful in the treatment of spontaneous chylothorax in the dog.

Kwang Bo Park - One of the best experts on this subject based on the ideXlab platform.

Sebastian Feuerlein - One of the best experts on this subject based on the ideXlab platform.

  • Cisterna Chyli in patients with malignancy influence of cardiovascular disease on the prevalence of the Cisterna
    European Journal of Radiology, 2011
    Co-Authors: Sebastian Feuerlein, Rainer Muche, Hansjuergen Brambs, Jochen Stolz, M Hetzel, Oliver Klass, Sandra Pauls
    Abstract:

    Abstract The purpose of this study was to investigate the potential correlation between the presence and size of the Cisterna Chyli (CC) on computed tomography (CT) and the presence of cardiovascular disease. Materials and methods Out of a 3000-patient cohort 2599 patients who received a CT examination of the chest and/or abdomen with measurable inferior vena cava and azygos vein were included in this retrospective study. To assess the presence of cardiovascular disease the following parameters were recorded from the PACS or clinical information system: diameter of vena cava and azygos vein, presence of ascitis, serum creatinine, history of congestive heart failure, coronary artery disease or arterial hypertension and medication (diuretics, beta-blocker). In addition the volume of the CC and the presence or absence of malignant disease were recorded. Mean values (vessel diameters, creatinine) or percentages were calculated and compared for the groups with (n = 416) and without (n = 2183) a Cisterna. Multivariate logistic regression analysis was performed for all parameters to identify the potential association with the presence and size of a Cisterna. In addition the simultaneous influence of the parameter malignancy, cardiovascular disease and age on presence and size of the CC was analyzed in a logistic regression model. Results The presence or absence of a CC was not associated with any of the measured parameter. Regarding the size of the CC, there was a positive correlation with the diameter of the azygos vein, the presence of ascitis and diuretic medication. The influences of malignancy, elevated central venous pressure and age on the development of a CC proved to be highly significant but could not be separated or quantified. Conclusion The volume of the Cisterna Chyli is influenced by pathologic states with an increased central venous pressure, while the presence or absence of the Cisterna seems to be independent of those factors.

  • Cisterna Chyli in patients with malignancy is there a correlation between changes in Cisterna volume and progression or regression of the tumor
    European Journal of Radiology, 2010
    Co-Authors: Sebastian Feuerlein, Rainer Muche, Markus S Juchems, Marco Kern, Andrea S Ernst, Sandra Pauls
    Abstract:

    UNLABELLED: The purpose of this study was to investigate the potential correlation between the size of the Cisterna Chyli (CC) and the tumor size in patients with malignancies on computed tomography (CT). MATERIALS AND METHODS: Out of a 3000 patient cohort 138 patients with histologically confirmed malignant disease, a detectable CC on CT and at least two CT scans within a 6 month period were included in this retrospective study. Out of 525 scans a total of 711 lesion intervals were evaluated. The volume of the CC and all target lesions (up to three per scan) were recorded. The Pearson correlation coefficient for the two parameters of changes in lesion size and CC size was calculated for the whole cohort and for a 33 patient subgroup that included only patients with tumors that showed the closest association with large CC in a previous study. RESULTS: The mean difference in lesion size for all 711 intervals was -1165μl. The mean difference in CC size for all 711 intervals was -46.6μl. The respective Pearson correlation coefficient was .05 with a non-significant p-value of .1823 (subgroup: r=.04, p=.6358). CONCLUSION: No significant correlation between the progression or regression of malignant disease and the size of the Cisterna Chyli could be found.

  • Cisterna Chyli in patients with malignancy—Is there a correlation between changes in Cisterna volume and progression or regression of the tumor?
    European Journal of Radiology, 2009
    Co-Authors: Sebastian Feuerlein, Rainer Muche, Markus S Juchems, Marco Kern, Andrea S Ernst, Sandra Pauls
    Abstract:

    UNLABELLED: The purpose of this study was to investigate the potential correlation between the size of the Cisterna Chyli (CC) and the tumor size in patients with malignancies on computed tomography (CT). MATERIALS AND METHODS: Out of a 3000 patient cohort 138 patients with histologically confirmed malignant disease, a detectable CC on CT and at least two CT scans within a 6 month period were included in this retrospective study. Out of 525 scans a total of 711 lesion intervals were evaluated. The volume of the CC and all target lesions (up to three per scan) were recorded. The Pearson correlation coefficient for the two parameters of changes in lesion size and CC size was calculated for the whole cohort and for a 33 patient subgroup that included only patients with tumors that showed the closest association with large CC in a previous study. RESULTS: The mean difference in lesion size for all 711 intervals was -1165μl. The mean difference in CC size for all 711 intervals was -46.6μl. The respective Pearson correlation coefficient was .05 with a non-significant p-value of .1823 (subgroup: r=.04, p=.6358). CONCLUSION: No significant correlation between the progression or regression of malignant disease and the size of the Cisterna Chyli could be found.

  • the Cisterna Chyli prevalence characteristics and predisposing factors
    European Radiology, 2009
    Co-Authors: Sebastian Feuerlein, Georg Kreuzer, Stefan A Schmidt, Rainer Muche, Markus S Juchems, A J Aschoff, Hansjuergen Brambs, Sandra Pauls
    Abstract:

    The purpose of this study was to determine the prevalence and characteristics of the Cisterna Chyli (CC) in a large 3,000-patient cohort and to identify potential predisposing factors for the development of a CC. Three thousand consecutive contrast-enhanced CT examinations (1,261 women, 1,739 men, mean age 61.0 years) of the chest and/or abdomen were included in this retrospective study. Imaging characteristics of the CC (size, attenuation, location) were documented as well as clinical information (malignant disease, pattern of metastasis). A CC was found in 16.1% of the patients with an average volume of 302 µl. The mean attenuation was 4.8 Hounsfield units (HU). Twenty percent of the CC showed CT densities of 15 HU and higher. Patients with malignancies showed a significantly (p 1,000 µl) represents an elevated relative risk for malignancy of 1.7 (p = 0.0017). We found a significant association between malignant disease and the presence and size of a Cisterna Chyli. Identifying the continuity between the CC and the thoracic duct is a safer method to distinguish a CC from retrocrural lymph nodes than near-water CT attenuation alone.

  • The Cisterna Chyli: prevalence, characteristics and predisposing factors
    European Radiology, 2009
    Co-Authors: Sebastian Feuerlein, Georg Kreuzer, Stefan A Schmidt, Rainer Muche, Markus S Juchems, A J Aschoff, Hansjuergen Brambs, Sandra Pauls
    Abstract:

    The purpose of this study was to determine the prevalence and characteristics of the Cisterna Chyli (CC) in a large 3,000-patient cohort and to identify potential predisposing factors for the development of a CC. Three thousand consecutive contrast-enhanced CT examinations (1,261 women, 1,739 men, mean age 61.0 years) of the chest and/or abdomen were included in this retrospective study. Imaging characteristics of the CC (size, attenuation, location) were documented as well as clinical information (malignant disease, pattern of metastasis). A CC was found in 16.1% of the patients with an average volume of 302 µl. The mean attenuation was 4.8 Hounsfield units (HU). Twenty percent of the CC showed CT densities of 15 HU and higher. Patients with malignancies showed a significantly (p < 0.001) higher prevalence of CC (340/1,757, 19.4%) than patients with benign conditions (144/1,243, 11.6%). Especially the finding of a large CC (>1,000 µl) represents an elevated relative risk for malignancy of 1.7 (p = 0.0017). We found a significant association between malignant disease and the presence and size of a Cisterna Chyli. Identifying the continuity between the CC and the thoracic duct is a safer method to distinguish a CC from retrocrural lymph nodes than near-water CT attenuation alone.

Charles R Leusner - One of the best experts on this subject based on the ideXlab platform.

  • retrograde cannulation of the thoracic duct and embolization of the Cisterna Chyli in the treatment of chylous ascites
    Journal of Vascular and Interventional Radiology, 2008
    Co-Authors: Derek Mittleider, Thomas A Dykes, K Cicuto, Steven M Amberson, Charles R Leusner
    Abstract:

    The authors offer a previously undescribed technique for Cisterna Chyli embolization in the treatment of chylous ascites. After the failure of conventional percutaneous direct Cisterna Chyli cannulation, the authors accessed the thoracic duct directly from the subclavian vein. Retrograde microcatheter access through the thoracic duct enabled embolization of the Cisterna Chyli. Embolization materials included fibered endovascular coils, gelatin sponge, and doxycycline. The patient's symptoms returned 10 days after embolization. This technique provided short-term success in the treatment of the patient's chylous ascites.